Port-au-Prince, Haiti; and Mexico City — With the first official case of cholera diagnosed by doctors in Haiti's capital, Port-au-Prince, and dozens of other cases suspected, officials and nongovernmental organizations are rushing to contain a potential outbreak.

The devastated city of about 3 million, half of whom are still homeless after the Jan. 12 earthquake, will be a formidable obstacle for groups trying to put preventive measures in place. Aid workers and officials say that in shantytowns and tent cities that sprung up after the quake, hundreds of thousands are without access to clean water and sanitation or proper medical care.

But unlike the outbreak that began in the Artibonite Valley, in the northern half of the country, late last month, officials have been able to prepare for a possible outbreak in the capital.

“The government finally announced … that it has reached Port-au-Prince, which is a good start and means that NGOs, too, are starting to meet with affected communities and acknowledge it,” says Kara Gibson, the medical director of Samaritan's Purse, an NGO providing medical aid to the Cite Soleil shantytown, near where the first case of cholera was diagnosed.

Concern about flooding from Hurricane Tomas

The government said Tuesday that a 3-year-old living in a camp near Cite Soleil, who had not left the vicinity of Port-au-Prince, tested positive for cholera. There are dozens of other suspected cases across the city, but numbers vary between government officials and organizations. It could also be days before the extent of the outbreak is known, as there is a lag in results from the testing laboratory.

Across the country, more than 580 people have died and over 9,000 cases are suspected in 10 regions. Officials say they worry that flooding provoked by Hurricane Tomas over the weekend could speed the spread of the disease.

Health workers are bracing to meet what they expect will be a sharp demand for help. "We expect transmission to be extensive, and we have to be prepared for it, there's no question," Jon Andrus, deputy director for the Pan-American Health Organization, said Tuesday. "We have to prepare for a large upsurge in numbers of cases and be prepared with supplies and human resources and everything that goes into a rapid response."

Groups working across the capital

Groups have been working across the capital to contain cholera, which is spread through contaminated water and food, teaching residents to employ preventive measures, especially washing hands and thoroughly cooking food. They are also setting up clinics.

The director of communications for Doctors Without Borders, Isabelle Jeanson, says their group has treatment centers operating all over the affected parts of the country and within four areas of Port-au-Prince. (The group says it has logged 200 cases of people in the capital with symptoms corresponding to cholera.)

Gabriel Timothee, a doctor and the executive director of the Haitian Health Ministry, said at a press conference Tuesday: "We've entered a new phase of seriousness in this cholera crisis ... we're passing from a passive to an active phase where we're going to search for cases.... This is a question of national security.... We have enough medical resources to deal with patients for now."

“When cholera is getting to the level when it is considered epidemic, it is a clear sign of lack of social development, a sign of lack of education," he said. "Cholera is treatable, it is more of an education problem. People who wash their hands, cook their food a certain way, have proper sanitation, don’t [suffer a] cholera epidemic, so it is clearly tied to the situation of Haiti.”

No latrines, no running water

Dr. Gibson says that preventive measures are particularly hard to implement in urban places like Cite Soleil. “Teaching has been a really successful tool," she says. “But in Cite Soleil, you can’t tell people ‘wash your latrine.‘ They have no latrine, no soap, or running water.”

Doctors Without Borders, for example, has provided about 280,000 liters of water per day in Cite Soleil, which covers about 14,000 people. Despite that effort, it is still less than the needs of the community, the group says.

The crowded capital also lacks space to quarantine patients and treat the spread.

Gibson says she spent a day scouring Port-au-Prince for places to establish a clinic and secured only a few empty plots of land. “This has been our greatest frustration,” she says. “We need a big site to accommodate a lot of people, but people just don't want to hand over their schools, churches, hospitals until the town is already sick.”

Aid workers will also struggle with limited information and discrepancies over the extent of the problem.

At the General Hospital in downtown Port-au-Prince, Yves Lambert, the head of infectious diseases, says the problem is growing. "When we first opened up the ward here we would receive about five patients a day," the doctor says. "In the past week, this has gone up to around 20."

Their tally, according to a nurse on duty who flipped through her hand written log book, shows that since Oct. 24, six people have died of cholera in the capital. The government tally counts just one suspected death in the city.